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Family CentredCare (FCC): A Social Collaboration to Improve Neonatal Health Arti Maria MD DM Neonatology Prof & Head Department of Neonatology Dr. RML Hospital and PGIMER, New Delhi
FCC: At a Glance Family Centered Care (FCC)
Family Centered Newborn Care in India Concept Genesis (2007) Overcoming HR constraint in NICU : Engaging Parent in Care Evidence Generation (RCT 2010-2013) Capacity building of accompanying parent attendant of a sick neonate for delivery of care & effect on neonatal outcomes Outcomes 1. Feasible & Safe 2. Breast feeding 3. Hospital stay 4. No in Infec on
Translation in Public Health 2014- till date Rajasthan (33 Districts) Madhya Pradesh (51 Districts) Bihar (Nalanda) Orissa ( 30 Districts) Andhra Pradesh Proposed Site
1. Audio Visual (AV) Modules
2. Training Guide 3. Operational Guidelines
Skill building process Induction at Admission (Sensitisation to FCC) Primary Care Provider Identified Daily Trainings Scheduled Skills imparted through demonstrations and practice
Skill building process contd. Supervised Learning Peer To Peer Learning Independent Doing DischargeCounseling
Attributes & Indicators of Implementation : Feasibility Parent- Attendant profile 3-20 % >50 years 23-61 % males (father, grandfather, uncles) 8-20% grandparents 65-70% mothers 22-25 % illiterate 110 % received the training Average time spentbedside by attendant was14.7 (± 1.1) hours/day
Attributes & Indicators of Implementation : Feasibility contd S. No. Care Provider Indicator Value 3 % of Nurse-Doctor who ever received sensitization to FCC June 16 76.9% (39) Dec 16 50% (42) 4 % of sensitized Nurse-Doctor For Nurse- who ever participated in Doctor conducting training sessions 16.6% (30) 42.8% (21) 5 % of daily training session held 59.5% (84) 77.4% (93)
Involvement of Parent-Attendants in Processes of Care ( June 16-December 16) ALoS (Days) 17,98 KMC Hrs (Avg) 1,65 %of Breast milk usage 42.68% Cleaning of a soiled baby 78.35% Positioning Nesting 69.39% 67.11% 0 20 40 60 80 100
Attributes & Indicators of Implementation : Acceptability A Qualitative Study* using In depth interviews Summary findings : 1. Positive attitudes toward FCC 2. Knowledge of essential newborn care giving practices among both parents and service providers. 3. Continuation of delivering essential newborn care by family beyond hospitalization. *An Independent Research Team of University Research Co India PvtLtd
ISN T IT APPEALING?... FCC Low cost Seemingly simple May supplement HR constraint Seems to have benefits for all stakeholders involved IS IT THAT SIMPLE? IS IT FEASIBLE?
Challenges in Implementation
Challenges w.r.t. heath care providers To accept parent-attendant as a co-partner in care delivery! Feeling of diminished authority! Uneasiness because of being constantly watched! Tendency for task shifting to mothers beyond the prescribed scope of activities!! They are expected to deliver a standard of care that an empowered parent now is aware of and expects from him!!!
Mother is already sold to the concept Selling the concept to doc/ nurse!! Much easier to define what mother is expected to do and she will do. Much harder is to expect the doctor not to task shift
Getting on board health care provider is the most important A module for health care provider What he should and what he shouldn t do; Need of initial sensitisationand training of entire heath care team (Nurses, doctors, other staff). Monitoring must include parameters to assess nurses performance of tasks. Adverse events and Hospital acquired infections must be watched.
To Conclude: Translating and adapting principles of Family CentredCare to capacity build the families for essential care giving skills through the captive period of hospitalisationof their sick neonate is feasible and acceptable. Health care providers have a pivotal role to play. The enhanced competencies and empowerment of mothers to provide continuum of care at home entrusts them with Social accountability for health of their infant Family Centered Care is a promising model of a Social Collaboration that is likely to have generational impact on neonatal health.
Family Centered Care for Sick Newborn: video links Family Centred Care (FCC): At A Glance- https://youtu.be/ui7ycftmd74 FCC : Parents experiences- https://youtu.be/bvaikd1nfaq Scaling up of FCC across the communities- https://youtu.be/28orapcze0u Resource material: Session 1- Nursery Entry Protocol- https://youtu.be/s2_nvcdskiy Session 2- Developmental supportive care- https://youtu.be/alogxc6-rqk Session 3- Kangaroo mother care- https://youtu.be/kkjnbyj-r9w Session 4- Care after discharge at home - https://youtu.be/hbd14bq1iy8
Requirements for FCC : A Checklist
Checklist contd.
FCC: Monitoring tool
Nursing monitoring sheet
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